Bill Text: NJ A1558 | 2016-2017 | Regular Session | Introduced
Bill Title: "The New Jersey Healthcare Choice Act"; permits health insurers licensed in other states to provide coverage in New Jersey under certain circumstances.
Spectrum: Partisan Bill (Republican 12-0)
Status: (Introduced - Dead) 2016-01-27 - Introduced, Referred to Assembly Financial Institutions and Insurance Committee [A1558 Detail]
Download: New_Jersey-2016-A1558-Introduced.html
STATE OF NEW JERSEY
217th LEGISLATURE
PRE-FILED FOR INTRODUCTION IN THE 2016 SESSION
Sponsored by:
Assemblyman JAY WEBBER
District 26 (Essex, Morris and Passaic)
Assemblywoman BETTYLOU DECROCE
District 26 (Essex, Morris and Passaic)
Assemblywoman AMY H. HANDLIN
District 13 (Monmouth)
Assemblywoman NANCY F. MUNOZ
District 21 (Morris, Somerset and Union)
Co-Sponsored by:
Assemblymen O'Scanlon, Wolfe, Carroll, DiMaio, C.A.Brown, Dancer, Space and Rible
SYNOPSIS
"The New Jersey Healthcare Choice Act"; permits health insurers licensed in other states to provide coverage in New Jersey under certain circumstances.
CURRENT VERSION OF TEXT
Introduced Pending Technical Review by Legislative Counsel.
An Act concerning the purchase of health insurance coverage and supplementing Title 17B of the New Jersey Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. This act shall be known and may be cited as "The New Jersey Healthcare Choice Act."
2. As used in this act:
"Commissioner" means the Commissioner of Banking and Insurance.
"Department" means the Department of Banking and Insurance.
"Foreign health insurer" means a foreign individual health insurer or a foreign small employer health insurer.
"Foreign individual health insurer" means an insurer licensed to sell individual health benefits plans in any other state.
"Foreign small employer health insurer" means an insurer licensed to sell small employer health benefits plans in any other state.
"Hazardous financial condition" means that, based on its present or reasonably anticipated financial condition, a foreign health insurer is unlikely to be able to meet obligations to policy holders with respect to known claims or to any other obligations in the normal course of business.
"Health care provider" means an individual or entity, which, acting within the scope of its licensure or certification, provides health care services, and includes, but is not limited to, a physician, dentist, nurse or other health care professional whose professional practice is regulated pursuant to Title 45 of the Revised Statutes, and a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.).
"Individual health benefits plan" means a benefits plan for persons and their dependents which pays or provides for hospital and medical expense benefits for covered services.
"Resident" means a person whose primary residence is in New Jersey and who is present in New Jersey for at least six months of the calendar year.
"Small employer health benefits plan" means a group benefits plan for persons and their dependents which pays or provides for hospital and medical expense benefits for covered services, offered by any person, firm, corporation or partnership actively engaged in a business that employs at least two but not more than 50 employees, who work a normal work week of 25 or more hours.
3. a. Notwithstanding any other law, rule, or regulation to the contrary, a foreign individual health insurer may offer and provide individual health benefits plans to residents in this State, if that insurer:
(1) offers the same individual health benefits plans in its domiciliary state and is in compliance with all applicable laws, regulations, and other requirements of its domiciliary state;
(2) obtains a certificate of authority to do business as a foreign health insurer in this State, pursuant to section 4 of this act; and
(3) participates, on a nondiscriminatory basis, in the "New Jersey Life and Health Guaranty Association" established pursuant to P.L.1991, c. 208 (C.17B:32A-1 et seq.).
b. Notwithstanding any other law to the contrary, a foreign small employer health insurer may offer and provide small employer health benefits plans to employers in this State, if that insurer:
(1) offers the same small employer health benefit plans in its domiciliary state and is in compliance with all applicable laws, regulations and other requirements of its domiciliary state; and
(2) obtains a certificate of authority to do business as a foreign health insurer in this State, pursuant to section 4 of this act; and
(3) participates, on a nondiscriminatory basis, in the "New Jersey Life and Health Insurance Guaranty Association;" established pursuant to P.L.1991, c. 208 (C.17B:32A-1 et seq.)
4. a. A foreign health insurer may apply for a certificate of authority to do business as a foreign health insurer in this State, using a form prescribed by the commissioner. Upon application, the commissioner shall issue a certificate of authority to the foreign health insurer unless the commissioner determines that the insurer:
(1) will not provide health insurance services in compliance with the provisions of this act;
(2) is in a hazardous financial condition, as determined by an examination by the commissioner conducted in accordance with the Financial Analysis Handbook of the National Association of Insurance Commissioners; or
(3) has not adopted procedures to ensure compliance with all federal laws and State laws, including applicable provisions of P.L.1985, c.179 (C.17:23A-1 et seq.), governing the confidentially of its records with respect to providers and covered persons.
b. A certificate of authority issued pursuant to this section shall be valid for three years from the date of issuance by the commissioner.
c. The commissioner shall establish by regulation:
(1) procedures for a foreign health insurer to renew a certificate of authority, pursuant to and consistent with the provisions of this act; and
(2) certificate of authority application and renewal fees, the amount of which shall be no greater than is reasonably necessary to enable the department to carry out the provisions of this act.
5. a. Each individual health benefits plan provided by a foreign individual health insurer to a resident of this State, and each application for the plan, shall disclose in plain language the following:
(1) the differences between the individual health benefits plan issued by the foreign health insurer, and a policy issued through the New Jersey Individual Health Coverage Program, pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.), using at least 14 point bold type to describe the differences that relate to: underwriting standards; premium rating; preexisting conditions; renewability; portability; and cancellation.
(2) an explanation of which state's laws govern the issuance of, and requirements under, the individual health benefits plan offered under this act.
b. Each group health benefits plan provided by a foreign small employer health insurer to an employer in this State, and each application for the plan, shall disclose in plain language the following:
(1) the differences between the small employer health benefits plan issued by the foreign health insurer, and a plan issued through the New Jersey Small Employer Health Benefits Program, pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.); and
(2) an explanation of which state's laws govern the issuance of, and requirements under, the small employer health benefits plan offered under this act.
6. a. The commissioner may deny, revoke, or suspend, after notice and opportunity to be heard, a certificate of authority issued to a foreign health insurer pursuant to this act for a violation of the provisions of this act, including any finding by the commissioner that a foreign health insurer is no longer in compliance with any of the conditions for issuance of a certificate of authority set forth in paragraphs (1), (2), or (3) of subsection a. of section 4 of this act, or the rules and regulations adopted pursuant to this act. The commissioner shall provide for an appropriate and timely right of appeal for the foreign health insurer whose certificate is denied, revoked, or suspended.
b. The commissioner shall establish grievance and independent claims review procedures with respect to claims by a health care provider or a covered person with which a foreign health insurer shall comply as a condition of issuing policies in this State. The procedures shall be consistent with those set forth in sections 11 through 14 of P.L.1997, c.192, (C.26:2S-11 through 26:2S-14), which establishes the Independent Health Care Appeals Program.
c. (1) The commissioner shall establish fair marketing standards for marketing materials used by foreign health insurers to market individual health benefits plans to residents in the State, which standards shall be consistent with those applicable to insurers that offer individual health benefits plans through the New Jersey Individual Health Coverage Program pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.).
(2) The commissioner shall establish fair marketing standards for marketing materials used by foreign health insurers to market small employer benefits plans to small employers in the State, which standards shall be consistent with those applicable to insurers that offer small employer health benefits plans through the New Jersey Small Employer Health Benefits Program pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.).
d. The procedures and standards established under subsections b. and c. of this section shall be applied on a nondiscriminatory basis so as not to place greater responsibilities on foreign health insurers than the responsibilities placed on other health insurers doing business in this State.
7. A foreign health insurer offering individual or small employer health benefits plans pursuant to this act shall comply with:
a. protections for insureds from unfair claims or trade practices applicable to health insurers pursuant to P.L.1947, c.379 (C.17:29B-1 et seq.);
b. applicable provisions of the "New Jersey Life and Health Insurance Guaranty Association Act," P.L.1991, c.208 (C:17B:32A-1 et seq.); and
c. the capital and surplus requirements set forth in section 2 of P.L.1995, c. 235, as determined to be applicable to foreign health insurers by the commissioner.
8. The Department of Banking and Insurance shall adopt, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), rules and regulations to effectuate the purposes of this act, provided, however, that the rules and regulations shall not:
a. Directly or indirectly require a foreign health insurer to, directly or indirectly, modify coverage or benefit requirements, or restrict underwriting requirements or premium ratings, in any way that conflicts with the insurer's domiciliary state's laws or regulations;
b. Provide for regulatory requirements that are more stringent than those applicable to carriers that are licensed by the commissioner to provide health benefits plans in this State; or
c. Require any individual
health benefits plan or small employer health benefits plan issued by the
foreign health insurer to be countersigned by an insurance agent or broker
residing in this State.
9. This act shall take effect on the 180th day following enactment.
STATEMENT
This bill allows health insurers licensed in other states to provide individual health benefits plans and small employer health benefits plans to New Jersey residents and to employers in New Jersey under certain conditions and under the oversight of the Commissioner of Banking and Insurance.
In order to offer plans in the State, the foreign health insurer would have to offer these plans in its domiciliary state and otherwise be in compliance with all applicable laws in that state. In addition, the foreign health insurer must apply for and obtain a certificate of authority to do business as a foreign health insurer from the Commissioner of Banking and Insurance. The commissioner shall issue the certificate if the commissioner determines that the foreign health insurer meets certain conditions as specified in the bill.
Foreign health insurers who provide individual health benefits plans or small employer health benefits plans in the State must make certain disclosures to individual residents or employers, related to the differences between these plans and plans currently permitted to be offered in the State.
The bill provides that the commissioner may deny, revoke or suspend a certificate of authority to do business as a foreign health insurer, after notice and an opportunity to be heard, and the commissioner must establish review procedures to handle claims by health care providers and covered persons against foreign health insurers.
The bill requires the commissioner to establish grievance and independent claims review procedures with respect to claims by a health care provider or a covered person, with which a foreign health insurer shall comply as a condition of issuing policies in this State.
The bill also requires the commissioner to establish fair marketing standards for marketing materials used by foreign health insurers to market individual health benefits plans and small employer health benefits plans in the State.
The bill requires foreign health insurers to comply with all applicable requirements of P.L.1947, c.379 (C.17:29B-1 et seq.) (relating to trade practices); P.L.1991, c.208 (C:17B:32A-1 et seq.) (relating to the New Jersey Life and Health Guaranty Association); and the capital and surplus requirements set forth in section 2 of P.L.1995, c.235, as determined to be applicable to foreign health insurers by the commissioner.
Finally, the bill requires the Department of Banking and Insurance to adopt regulations to effectuate the purposes of the bill. However, the department's regulations shall not: (1) require a foreign health insurer to modify coverage or benefit requirements, or restrict underwriting requirements or premium ratings, in any way that conflicts with the insurer's domiciliary state's laws or regulations; (2) provide for an expansion of the commissioner's authority over foreign health insurers in a way that conflicts with the provisions of this bill; or (3) require any individual health benefits plan or small employer health benefits plan issued by the foreign health insurer to be countersigned by an insurance agent or broker residing in this State.
Health insurance regulations vary from state to state and, as a result, the cost for individual health coverage and small employer health coverage also varies widely. By allowing insurers licensed in other states to offer coverage to individuals and employers in this State, the intent of the bill is to provide New Jersey residents with access to a wider range of affordable health benefits plans.
